NAV-ANT-04

Code
NAV-ANT-04
Mercy ID
V-03292-21
Encounter Date
03/17/2010
Last
Navarrete
First
Antonio
DOB
11/23/2005
County
Dekalb
Street
3132 Buford Hwy. Apt. E-3
City
Atlanta
State
GA
Zip
30329-
Cell
(404) 438-2219
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Doubling Up
Education Level
Preschool
Home Owner
YES

Parents Information

Name DOB COB
Mother Maria adalis olmedo 02/28/1979 Mexico
Father Antonio Navarrete 06/13/1972 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Asma
Lives With
Mother
Name of School
Joshiba Head Start
Grade
Kinder
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
YES
Intake
C. Martinez
Data Entry
J. Manzo